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News

11Sep 2017

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DNA sequencing could open up new drug indications for patients with cancer

Thanks to DNA sequencing, patients with rare cancers for which no standard treatment is available could receive existing therapies that work in patients treated for different cancers, but who carry the same genetic mutations. The first results of a multi-drug and multi-tumour clinical trial, presented at the ESMO 2017 Congress, show that this kind of precision oncology trial is not only feasible, but also has the potential to identify patient subgroups who could benefit from existing drugs outside of their registered indication.

In the Netherlands, a network of more than 40 hospitals systematically performs Whole Genome Sequencing (WGS) on patients with metastatic cancer in order to create a database that now comprises about 2,000 individuals treated for all types of cancer.

"By sequencing the whole genome in so many patients, we found commonalities between tumours and DNA mistakes. For example, the ERBB2 gene is mainly screened for in breast cancer patients, but we know that it is also present in patients with other tumour types," said principal study investigator Prof. Emile Voest, from the Netherlands Cancer Institute in Amsterdam.

"Now that we are able to identify these patients, the question is: How can we get them to benefit from existing, potentially active drugs? That is the basis for our Drug Rediscovery Protocol, which currently includes 19 different drugs from 10 pharmaceutical companies," Voest reported.

Since the trial was launched in late 2016, over 250 cases have been submitted for review: Of these, about 70 patients have so far been found eligible and started treatment. Adult patients with solid tumours, glioblastoma, lymphoma or multiple myeloma with no standard treatment options were enrolled in the study in multiple parallel cohorts according to tumour type and trial drug.

 "We have preclinical evidence and case reports suggesting that certain drugs, which patients with a given genetic aberration and a certain type of cancer are sensitive to, could equally be active in patients with the same mutation in other tumour groups. However, we also know that the tissue background is extremely important: That's why we create study cohorts not just according to

The efficacy of the treatment for each cohort is analysed in a two-stage process: "If in stage one, the first group of eight patients with the same tumour type and genetic mutation responds to the treatment, we expand the cohort to 24 patients in stage two to get a stronger indication of the clinical benefit," said Voest. "Clinical benefit, in this case, is defined as either a complete remission, a partial response, where the tumour shrinks by more than 50 percent, or disease stability for at least 16 weeks." 

To date, a clinical benefit has been observed in 37 percent of trial participants, and six of the 20 study cohorts have graduated to stage two. "We've seen real success with several anticancer drugs, including immunotherapy, a PARP inhibitor and an antibody combination," Voest reported.

 "Our team is quite excited about these results, because everybody knows that developing new drugs is very expensive. With this study, we are providing a platform for expanding the indications of existing drugs and utilising them to their full potential," he said. "Using drugs that are already available based on DNA sequencing is a truly novel approach to personalising medicine, and we are talking to regulatory authorities to see how new findings in this area can be translated to the clinic as quickly as possible for these rare subsets of patients."

 

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